Application for graduate study

1. Course Title Title of course or research degree for which you are applying: Either Taught Course (eg, MA, MSc, MFA, MAPH, MRES, LLM, Diploma, Certificate) Title: Or Research Degree (MA/MSc by Dissertation, MPhil, PhD (Doctoral Programme), PhD, Integrated PhD) Title: Title of research proposal (research candidates only)

School/Department/Centre: Date commencing: Full-time Proposed period of study: Part-time

Distance PhD

2. Personal Details Application or Postgraduate number, if you have previously applied AP/PG Surname or family name:
(as on your passport/travel document)

Other name(s)
(as on your passport/travel document)

Former surname: Male

Title (Mr/Mrs/Ms/Miss/Dr)

Female

Date of Birth: Nationality: Country of Origin: First Language:

Day

Month

Year

Passport Number
(non EU international students only)

Place of Birth:
(Country if overseas nationality) (County, if UK nationality)

Country of Permanent Residence:

Do you have a disability, special need or medical condition that may require extra support or specific facilities for accommodation? No

Yes

Please provide further details in Section 9. Permanent Home address

Correspondence address

Telephone number: Fax: E-mail address: Applicable dates:

Telephone number: Fax: E-mail address: Applicable dates:

Form No. ADM.34 (a) (Sept 2009)

3. Fees and Source of Finance (i) Fees classification Permanent residence UK

EU

Country:

Country:

Outside EU

If you are already following a course in the UK, please indicate how you have been classified for fees purposes: Home Student

European Union Student

Overseas Student

Is the length of your stay in the UK currently limited by immigration control. If yes, give details.

If you were born in the UK or EU but are working temporarily outside the EU, please give dates, countries and occupations:

(ii) Source of finance For example, self/family, studentship

4. Academic Qualifications (i) Qualifications completed Title of first degree: Main subjects: Awarding Institution:
(University or other)

Name and address: Class or or mark awarded: Postgraduate degree: Main subjects: Awarding Institution:
(University or other)

Date awarded:

Name and address: Class or mark awarded: Date awarded:

(ii) Qualifications pending

Title of first degree: Main subjects: Awarding Institution:

(University or other)

Name and address: Class or mark expected: Expected date of award:

Form No. ADM.34 (b) (Sept 2009)

4. Academic Qualifications (continued) Postgraduate degree Main subjects: Awarding Institution:

(University or other)

Name and address: Class or mark expected: Expected date of award:

5. Languages If English is not your first language, please give English language qualifications (for example TOEFL or IELTS), and level and date obtained.

Languages known (other than English) and present standard:

6. Other Information Employment history:

Other relevant information (professional or academic):

How did you hear of this course at the University of Essex:

7. Academic References First referee Name: Address: Title: Second referee Name: Address: Title:

Telephone/Fax number:

Telephone/Fax number:

E-mail address:

E-mail address:

Form No. ADM.34 (c) (Sept 2009)

8. Information required by the School, Department or Centre to which you are applying: (can be continued on additional paper)

9. Disability If you have a disability, a specific learning difficulty or medical condition including any which might require special arrangements or facilities, please provide further details. Information on disability will be shared with the Disability Advisor who can provide further information and advice. If you have any questions about disability provision at the University, please e-mail disab@essex.ac.uk or telephone 01206 872365. (can be continued on additional paper)

10. Criminal convictions Please tick if you have a criminal conviction

Applicants are required to declare at the point of application if they have a criminal conviction. In general, you are not required to disclose spent convictions as defined by the Rehabilitation of Offenders Act 1974. However, you should be aware that courses involving work with children or vulnerable adults, including the elderly or sick, are exempt from the Rehabilitation of Offenders Act 1974 and in this case ALL criminal convictions must be disclosed even if they are spent or occurred whilst you were a juvenile. If you are convicted of a criminal offence or receive a Police caution after you have applied, you must inform the University. Disclosures should be made in writing to the Head of Admissions.

Signed:

Date:

Please enclose all documents required by your School, Department or Centre. You should make arrangements for the appropriate documents to be attached to the completed application form and mailed to the Graduate
Administrator of the School, Department or Centre to which you are applying, together with specific information for the School, Department or Centre.

Data Protection Collection for Applicants

During the admissions process, all information you supply to the University as part of your application is processed in accordance with the provisions of the Data Protection Act, is only disclosed within the University to members of staff who need to know it in order to carry out their duties, and is used for the sole purpose of managing the application process. Where required as part of this process we will check the accuracy of your data against external sources, and may also confirm your data to other higher education institutions or government agencies. If your application is successful and you register as a student, some or all of this information will form part of your student record. If you firmly accept your place at the University, your details may be shared with the University of Essex Students Union before registration to provide you with access to the Union and its services, as well as to enable the University to fulfil its legal obligation to support the operation of a fair and democratic students union.

Form No. ADM.34 (d) (Sept 2009)